Feasibility and Preliminary Efficacy of Integrative Neuromuscular Training for Childhood Cancer Survivors: A Pilot...

Survivors of childhood acute lymphoblastic leukemia (ALL) often exhibit early deficits in muscle and movement competence, which can compromise long-term health. Integrative neuromuscular training (INT), a multifaceted approach combining fundamental movement activities with strength exercises, may help address these deficits during critical developmental periods.

Eight children treated for ALL (aged 6-12 years) completed a supervised INT intervention (2 sessions/week for 8 weeks). Primary outcomes were feasibility (recruitment, retention, adherence, compliance, and tolerance) and program acceptability. Secondary outcomes included muscle function (isometric midthigh pull [IMTP], countermovement jump, and handgrip strength), dual-energy x-ray absorptiometry (DXA)-derived body composition, peripheral quantitative computed tomography (pQCT)-derived muscle measures, and health-related quality of life assessed using the Pediatric Quality of Life Inventory (PedsQL). Pre- to post-intervention changes were evaluated using paired tests (paired t-tests or Wilcoxon signed-rank tests, depending on normality) and corresponding effect sizes (Cohen's d or rank-biserial correlation).

Recruitment was 80%, retention was 100%, and adherence was 100%, although the intervention extended beyond 8 weeks. The program was well-tolerated and demonstrated high acceptability, with no adverse events reported. Exploratory analyses suggested improvements in muscle strength (IMTP and countermovement jump peak force, and left handgrip strength), modest increases in whole-body lean mass, and specific PedsQL domains (school functioning, general fatigue, cognitive fatigue), with limited changes in muscle power and pQCT-derived muscle measures.

INT is feasible and acceptable for survivors of childhood ALL, though maintaining twice-weekly attendance was challenging. Preliminary results indicate potential benefits for muscle strength, mass, and specific quality-of-life domains, underscoring the need for strategies to support consistent participation in this population.